The goal of the 1Florida ADRC is to advance the understanding of Alzheimer?s disease and Related Disorders (ADRDs), especially in underrepresented minority groups. Among 370 participants currently recruited at Mount Sinai Medical Center (MSMC), 60% are Hispanic, with a retention rate of ~80%, over 50% are normal or have various stages of Mild Cognitive Impairment (MCI). Structural MRI has been obtained on 90% and amyloid PET (aPET) scans on ~70% of participants (comprising 1/3 of all aPET scans in NACC). Autopsy has been obtained on over 95% of those consented, including > 50% from Hispanic decedents. Novel neuropsychological instruments in English and Spanish have been developed and utilized to detect cognitive impairment before it is detectable by standard assessments. The effects of language, culture, acculturation and bilingualism among minority groups on cognitive and functional performance, the demographic and genetic factors that affect the threshold for amyloid positivity and the differential effect of APOE genotype on amyloid load in Hispanics versus non-Hispanics have been studies in depth. In the current P30 application, we propose to expand the clinical core to include MSMC as well as University of Miami (UM), where recruitment and retention of AA participants has been very successful and expertise in evaluating vascular comorbidities and contributions to dementia exists, and the University of Florida (UF), Gainesville, where considerable expertise exists in evaluation and studies of Lewy Body Disease (LBD) and early Parkinson?s disease. In total we propose to recruit 600 participants (~40% Hispanic, ~40% White non- Hispanic [WNH], and ~20% AA), including 100 new participants at each of three sites and at least 200 follow- ups at MSMC and 100 follow-ups each at UM and UF. All new participants will receive MRI and aPET scans. Follow-up participants will also receive repeat MRI scans and most will receive aPET scans. Blood-based biomarker assessments (A?42:40, NFL, and others) will be used to complement the imaging and neuropsychological assessments. Clinical Core activities will be integrated closely with ORE, REC, Biomarker and Pathology Cores, and harmonized across the three clinical sites with respect to consistency of assessments, biospecimens, biomarker studies, standardized implementation of all NACC modules, LBD and vascular assessments diagnostic methodology. Utilization of elements of the NIA-AA Research Framework ATN classification (Amyloid, Tau, Neurodegeneration) will be implemented. Methods and metrics will be used to ensure full integration between the sites, including recruitment and enrollment for brain autopsies, which will be done at all three sites, with correlation of imaging findings to regional brain pathology and structural changes. Qualified investigators and the larger ADRD community will receive access to Clinical Core participants and their data and biospecimens for research projects and education, training purposes.